Massachusetts gift ban under attack (again)

Massachusetts legislators aren't just sick of the Prescriptions Drug Gift Ban -- they're looking to wipe it from the books. Four years after the ban on gifts and food and a requirement that all tokens be accounted for and out in the open, the state's House of Representatives is looking to dismantle it. It's a familiar story by now, but the 2012 version is unique in that it's an all-out attack, where previous efforts have aimed to pare back the law.

Proponents of banning the ban include the Massachusetts Restaurant Association, whose members have suffered from provisions barring drug companies from buying healthcare professionals meals. Director of government affairs Stephen Clark told MM&M that the industry is looking for some parity: state law allows drugmakers to bring food into offices if it's part of an educational program, but they can't take the doctor out and discuss matters over drinks.

“We support the gift ban,” he said. Clark said the association stopped tracking money that flowed into restaurants as a result of medical conferences once the law went into effect in 2008, but said restaurants could bring in $200,000 to $400,000 in receipts. Clark said he couldn't attribute any decline in industry sales to the ban because the recession ate into business over the past few years. The latest State figures indicate the food industry is doing well despite the ban.

The House is also looking to bring co-pay cards into Massachusetts, which is the only state that doesn't allow the discount cards to be used. Co-pay cards are the subject of a multi-state lawsuit (Massachusetts is not included) that casts them as a form of fraud because they insulate patients from the design of their insurance plans' formularies. The suit also says the cards dupe insurers because insurance companies don't see the co-pay card at the time of the patient transaction, meaning they only realize they are picking up a greater percentage of the drug's cost when accounts are reconciled. Pfizer, Amgen, AstraZeneca and Bristol-Myers Squibb are among the defendants.

A study by the Pharmaceutical Care Management Association estimates that overthrowing the ban would increase the state's medical costs for unions, employers and state agencies by $750 million in ten years. A CVS Pharmacy Adherence Report says the state has a 79% generics usage rate.

“Right now Massachusetts is making a real effort to help control rising healthcare costs. . . and the repeal [would be] a step backwards,” Alyssa Vangeli, a policy analyst for the interest group Healthcare for All told MM&M.

Vangeli says the ban on co-pay cards makes financial sense and that the ban on off-premises food was a compromise. “The reason this law passed in the first place as to minimize and conflict of interest” she said.

Vangeli added that although many medical schools and medical communities have their own rules barring doctors from accepting gifts, the state bans are there as a backstop for those organizations that do not have their own guidelines in place.

“A patient should never have to wonder if [their doctor] been influenced by some other gift or payment of a meal” she said.

Proponents of co-pay cards have defended the discount cards as the means to a medically essential end: adherence.

The state's Senate Ways and Means Committee issues its version of the 2013 FY budget next month. The two houses will convene a conference committee to reconcile their two plans in June.

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